| NPI | 1801526934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704353868NSA220HG) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704353868) |
| 363LF0000X Nurse Practitioner, Family (Licence: HI APRN-4144-0) | |
| Enumeration Date | 2022-06-13 |
| Last Update Date | 2024-09-24 |