| NPI | 1679062418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 28550) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704286117) |
| Enumeration Date | 2018-05-08 |
| Last Update Date | 2022-08-24 |