| NPI | 1659828663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704323970) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95002731) |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2016-10-06 |