| NPI | 1295164382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MI 4704263685) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704263685) |
| Enumeration Date | 2013-11-08 |
| Last Update Date | 2026-03-05 |