| NPI | 1962784116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9383285) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4074245548) |
| Enumeration Date | 2011-09-14 |
| Last Update Date | 2024-08-15 |