| NPI | 1194291179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: MI 4704211443) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: MI 4704211443) |
| Enumeration Date | 2018-10-17 |
| Last Update Date | 2018-10-17 |