| NPI | 1437727641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704321024) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704321024) |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2023-09-18 |