| NPI | 1346753415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: KY 3011910) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: MI 4704257840) |
| Enumeration Date | 2017-11-13 |
| Last Update Date | 2017-12-07 |