NPI | 1104378264 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MI 4704249478) |
Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: MI 4704249478) |
Enumeration Date | 2016-10-25 |
Last Update Date | 2016-10-25 |