| NPI | 1457716649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704227162) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN 2460608) |
| Enumeration Date | 2015-12-15 |
| Last Update Date | 2022-08-24 |