| NPI | 1730893264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704363298) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704363298) |
| Enumeration Date | 2023-01-10 |
| Last Update Date | 2024-01-04 |