| NPI | 1073327540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704370915) |
| Additional Taxonomies | 163WX0800X Registered Nurse, Orthopedic (Licence: MI 4704370915) |
| Enumeration Date | 2025-02-05 |
| Last Update Date | 2025-06-02 |