| NPI | 1922631258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 347334) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704296154) |
| Enumeration Date | 2020-02-14 |
| Last Update Date | 2023-09-05 |