| NPI | 1750100442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MI AG07240076) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: MI AG07240076) |
| 163W00000X Registered Nurse (Licence: MI 4704238185) | |
| Enumeration Date | 2024-10-09 |
| Last Update Date | 2024-10-18 |