| NPI | 1558815787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71008591A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704274083) |
| Enumeration Date | 2016-08-04 |
| Last Update Date | 2021-09-03 |