| NPI | 1750842167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: KY 1174972) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: MI F02190895) |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2022-11-09 |