| NPI | 1447611553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704276496) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX 1230265) |
| Enumeration Date | 2016-03-16 |
| Last Update Date | 2026-05-14 |