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 |