| NPI | 1346861440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MI 4704317868) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: MI 4704317868) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: MI 4704317868) | |
| Enumeration Date | 2020-04-29 |
| Last Update Date | 2024-05-08 |