| NPI | 1881005908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704252058) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704252058) |
| Enumeration Date | 2014-05-12 |
| Last Update Date | 2017-04-07 |