| NPI | 1497467799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704304468) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: MI 4704304468) |
| 363L00000X Nurse Practitioner (Licence: MI 4704304468) | |
| Enumeration Date | 2022-12-19 |
| Last Update Date | 2023-01-18 |