| NPI | 1427611870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MI 4704287451) |
| Additional Taxonomies | 163WW0000X Registered Nurse, Wound Care (Licence: MI 4704287451) |
| Enumeration Date | 2019-04-20 |
| Last Update Date | 2019-06-10 |