| NPI | 1770283988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704351728) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704351728) |
| Enumeration Date | 2023-03-06 |
| Last Update Date | 2023-12-22 |