| NPI | 1043084395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 270547) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704365610) |
| Enumeration Date | 2023-11-07 |
| Last Update Date | 2024-09-25 |