| NPI | 1881158749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704306900) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI F11180493) |
| Enumeration Date | 2019-01-24 |
| Last Update Date | 2020-12-28 |