| NPI | 1497217822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704303926) |
| Additional Taxonomies | 163WC0400X Registered Nurse, Case Management (Licence: MI 4704303926) |
| Enumeration Date | 2019-04-04 |
| Last Update Date | 2019-06-18 |