| NPI | 1871908897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704248035) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704248035) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MI 4704248035) | |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2025-12-09 |