| NPI | 1578234910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI F07211240) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704276203) |
| Enumeration Date | 2021-09-24 |
| Last Update Date | 2021-09-24 |