NPI | 1578035895 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11029371) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704292697) |
Enumeration Date | 2018-12-27 |
Last Update Date | 2024-10-02 |