| NPI | 1073991477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MI 4704250106) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 11024811) |
| Enumeration Date | 2015-05-18 |
| Last Update Date | 2023-07-12 |