| NPI | 1194590810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704258725) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 35557) |
| Enumeration Date | 2023-11-22 |
| Last Update Date | 2025-03-17 |