| NPI | 1750784344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MI 4704276056) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704276056) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: MI 4704276056) | |
| Enumeration Date | 2014-09-26 |
| Last Update Date | 2024-03-20 |