Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 4704250106 | MI |
NPI | 1073991477 |
---|---|
Provider Name | Mr. James L Tougas |
First Address | Fenton, MI 48430-9455 |
Second Address | Fenton, MI 48430-9455 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2015 |
Last Update Date | 18/05/2015 |