| NPI | 1548327760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 1477) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704270788) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2009-09-01 |