| NPI | 1902374267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704289789) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704289789NSA180SS) |
| Enumeration Date | 2018-11-05 |
| Last Update Date | 2025-02-20 |