| NPI | 1669098810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MI 4704287507) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704287507) |
| 363LF0000X Nurse Practitioner, Family (Licence: MI 4704287507) | |
| Enumeration Date | 2020-06-24 |
| Last Update Date | 2023-11-06 |