| NPI | 1760615777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MI 4704235156) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: MI 4704235156) |
| Enumeration Date | 2009-08-25 |
| Last Update Date | 2023-11-02 |