| NPI | 1881122935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704184761) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704184761) |
| Enumeration Date | 2017-06-01 |
| Last Update Date | 2021-07-02 |