| NPI | 1043561277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 33656) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704252765) |
| Enumeration Date | 2012-09-27 |
| Last Update Date | 2023-09-07 |