| NPI | 1962924084 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MI 4704217795) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704217795) |
| Enumeration Date | 2017-07-11 |
| Last Update Date | 2021-02-17 |