| NPI | 1639560030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MI 4704198315) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704198315) |
| Enumeration Date | 2015-02-07 |
| Last Update Date | 2023-12-12 |