| NPI | 1629867973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MI 4704401501) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: MI 4704401501) |
| Enumeration Date | 2025-05-03 |
| Last Update Date | 2025-09-04 |