| NPI | 1023817392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704267985) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704267985) |
| Enumeration Date | 2025-03-10 |
| Last Update Date | 2025-05-29 |