| NPI | 1083954770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MI 4704259285) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704259285) |
| Enumeration Date | 2013-02-18 |
| Last Update Date | 2017-03-18 |