| NPI | 1871007146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MI 4704301140) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 1035992) |
| Enumeration Date | 2017-11-25 |
| Last Update Date | 2024-04-30 |