| NPI | 1912443839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MI 4704246718) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MI 4704246718) |
| 163W00000X Registered Nurse (Licence: MI 4704246718) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704246718) | |
| Enumeration Date | 2017-01-17 |
| Last Update Date | 2021-02-08 |