| NPI | 1629473228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MI 4704230300) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: MI 4704230300) |
| 363L00000X Nurse Practitioner (Licence: MI 4704230300) | |
| Enumeration Date | 2014-10-27 |
| Last Update Date | 2021-11-04 |