| NPI | 1790397040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704270749) |
| Additional Taxonomies | 163WH1000X Registered Nurse, Hospice (Licence: MI 4704270749) |
| Enumeration Date | 2020-08-18 |
| Last Update Date | 2024-12-24 |