| NPI | 1679190466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MI 4704321740) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704321740) |
| Enumeration Date | 2020-06-29 |
| Last Update Date | 2022-12-06 |