| NPI | 1255722104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704320170) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN216775) |
| 363LF0000X Nurse Practitioner, Family (Licence: MD AC001668) | |
| 363LF0000X Nurse Practitioner, Family (Licence: VA 0024175325) | |
| Enumeration Date | 2015-02-13 |
| Last Update Date | 2024-08-29 |