NPI | 1710601570 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MI 4704246900) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4704246900) |
Enumeration Date | 2022-09-26 |
Last Update Date | 2025-08-12 |