| NPI | 1447768403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MI 4704325154) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: MI 4704325154) |
| Enumeration Date | 2018-01-11 |
| Last Update Date | 2026-02-03 |