| NPI | 1598198673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704242509) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71007785A) |
| Enumeration Date | 2013-08-13 |
| Last Update Date | 2023-08-15 |