| NPI | 1871683177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MI 4704128692NSA17450) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4734328692) |
| 163WA2000X Registered Nurse Administrator (Licence: MI 4734328692) | |
| Enumeration Date | 2006-10-15 |
| Last Update Date | 2017-11-21 |