| NPI | 1952041329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704290234) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: MI 4704290234) |
| Enumeration Date | 2022-03-31 |
| Last Update Date | 2023-03-21 |