| NPI | 1558035469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95026599) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI F09201243) |
| Enumeration Date | 2021-08-04 |
| Last Update Date | 2023-09-15 |