| NPI | 1740932615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704315663) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: MI 4704315663) |
| Enumeration Date | 2022-01-22 |
| Last Update Date | 2024-04-24 |