| NPI | 1154195923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 34704346298) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704346298) |
| Enumeration Date | 2023-11-13 |
| Last Update Date | 2025-03-10 |