| NPI | 1538828280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: MI 4704305333) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: MI 4704305333NSA210ZT) |
| Enumeration Date | 2021-12-09 |
| Last Update Date | 2023-10-04 |