| NPI | 1326030727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LX0001X Nurse Practitioner, Obstetrics & Gynecology (Licence: MI 4704146078) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MI 4704146078) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2007-07-15 |