| NPI | 1841649761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95004389) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704258435) |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2018-03-28 |