| NPI | 1780607853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4704213286) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704213286) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2012-04-25 |