| NPI | 1750973244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MI 4704346275) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704346275) |
| Enumeration Date | 2021-02-07 |
| Last Update Date | 2022-05-24 |