| NPI | 1245805233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MI 4704185650) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: MI 4704185650NSA210CL) |
| Enumeration Date | 2021-05-23 |
| Last Update Date | 2021-05-28 |