| NPI | 1053072561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704366072) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704366072) |
| Enumeration Date | 2022-01-06 |
| Last Update Date | 2024-07-23 |