| 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 |