| NPI | 1265987283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704223748) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: NM CNP-03033) |
| Enumeration Date | 2016-08-19 |
| Last Update Date | 2017-12-08 |