| NPI | 1639703473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MI 4704276874) |
| Additional Taxonomies | 163WC1400X Registered Nurse, College Health (Licence: MI 4704276874) |
| 163WG0000X Registered Nurse, General Practice (Licence: MI 4704276874) | |
| Enumeration Date | 2020-03-02 |
| Last Update Date | 2021-06-02 |