| NPI | 1891239026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MI 47004274081) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: FL APRN11002111) |
| Enumeration Date | 2016-12-07 |
| Last Update Date | 2020-06-01 |