| NPI | 1225506132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704294870) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704294870) |
| Enumeration Date | 2018-11-08 |
| Last Update Date | 2024-09-12 |