| NPI | 1588082051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MI L163015) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI L2359348) |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2015-11-19 |