| NPI | 1932771904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704318579) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704318579) |
| Enumeration Date | 2021-07-10 |
| Last Update Date | 2021-11-01 |