| NPI | 1003512856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MI 4704371368) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704371368) |
| Enumeration Date | 2023-02-03 |
| Last Update Date | 2024-08-25 |