| NPI | 1922568492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704296628) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704296628) |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2024-11-05 |