| NPI | 1598700593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601003728) |
| Additional Taxonomies | 364SF0001X Clinical Nurse Specialist Family Health (Licence: NY 0067981) |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2007-12-11 |