| NPI | 1831687110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704371702) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NM CNP-03548) |
| 363LF0000X Nurse Practitioner, Family (Licence: NM CNP-03548) | |
| Enumeration Date | 2018-04-23 |
| Last Update Date | 2021-06-16 |