| NPI | 1427721182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704322814) |
| Additional Taxonomies | 364SF0001X Clinical Nurse Specialist, Family Health (Licence: MI 4704322814) |
| Enumeration Date | 2021-07-28 |
| Last Update Date | 2021-09-02 |