| NPI | 1922305929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704278150) |
| Additional Taxonomies | 174H00000X Health Educator (Licence: 21310526) |
| 163W00000X Registered Nurse (Licence: MI 4704278150) | |
| Enumeration Date | 2011-02-28 |
| Last Update Date | 2016-05-04 |