| NPI | 1669587085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MI 4704211785) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704211785) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2011-11-02 |