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 |