| NPI | 1699857748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MI 4704184595) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704184595) |
| 363LF0000X Nurse Practitioner, Family (Licence: IN 71002233A) | |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2021-10-19 |