| NPI | 1164731535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704314515) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 3903890) |
| 163W00000X Registered Nurse (Licence: WI 154692-030) | |
| 363L00000X Nurse Practitioner (Licence: MI 4704314515) | |
| 363LF0000X Nurse Practitioner, Family (Licence: WI 4211-33) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MI 3920511) | |
| Enumeration Date | 2010-10-01 |
| Last Update Date | 2023-03-16 |