| NPI | 1861926636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704350380) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: MI 4704350380) |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2024-08-23 |