| NPI | 1225620032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1123912) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704317818) |
| 363LF0000X Nurse Practitioner, Family (Licence: MI 4704317818) | |
| Enumeration Date | 2021-02-03 |
| Last Update Date | 2024-03-14 |