| NPI | 1245951870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704341284) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704341284) |
| 363LF0000X Nurse Practitioner, Family (Licence: MI 2023000523) | |
| Enumeration Date | 2022-09-12 |
| Last Update Date | 2023-04-29 |