| NPI | 1013213958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704230530) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704230530) |
| Enumeration Date | 2011-02-09 |
| Last Update Date | 2012-09-10 |