| NPI | 1396211702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R251622) |
| Additional Taxonomies | 163WC0400X Registered Nurse, Case Management (Licence: MI 4704320054) |
| 163WG0000X Registered Nurse, General Practice (Licence: MI 4704320054) | |
| 163WH0200X Registered Nurse, Home Health (Licence: MI 4704320054) | |
| 163WM0705X Registered Nurse, Medical-Surgical (Licence: MI 4704320054) | |
| Enumeration Date | 2018-10-23 |
| Last Update Date | 2024-06-12 |