| NPI | 1598101255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MI 4704274075) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704274075) |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2014-03-17 |