| NPI | 1164174116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704350170) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: MI 4704350170) |
| Enumeration Date | 2022-01-20 |
| Last Update Date | 2025-12-27 |