| NPI | 1790306405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704318347) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: MI 4704318347) |
| Enumeration Date | 2020-05-04 |
| Last Update Date | 2021-08-06 |