| NPI | 1679230148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MI 4704335001) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: MI 21314035126) |
| Enumeration Date | 2021-11-19 |
| Last Update Date | 2022-04-05 |