| NPI | 1538772397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704374041) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 176174) |
| 363L00000X Nurse Practitioner (Licence: WI 10627-33) | |
| Enumeration Date | 2020-08-31 |
| Last Update Date | 2022-12-23 |