| NPI | 1447844089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704278668) |
| Additional Taxonomies | 163WF0300X Registered Nurse, Flight (Licence: MI 4704278668) |
| Enumeration Date | 2021-02-24 |
| Last Update Date | 2022-03-26 |