| NPI | 1891407839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP2201X Registered Nurse, Ambulatory Care (Licence: MI 4704285519) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: MI 4704285519) |
| Enumeration Date | 2022-12-21 |
| Last Update Date | 2022-12-21 |