| NPI | 1396311510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704342731) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704342731) |
| 363LF0000X Nurse Practitioner, Family (Licence: KY 3017125) | |
| Enumeration Date | 2021-05-28 |
| Last Update Date | 2024-08-13 |