| NPI | 1023477056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704241201) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704241201) |
| Enumeration Date | 2016-02-18 |
| Last Update Date | 2016-03-07 |