| NPI | 1962822106 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL HOLLIS Owner 317-744-5368 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine |
| 213EP1101X Podiatrist, Primary Podiatric Medicine | |
| Enumeration Date | 2014-04-25 |
| Last Update Date | 2019-08-30 |