| NPI | 1437867793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704191949) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704191949) |
| Enumeration Date | 2022-11-07 |
| Last Update Date | 2023-01-31 |