| NPI | 1588636948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704164055) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO 179267) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2023-08-21 |