| NPI | 1982191169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1077676) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704266333) |
| Enumeration Date | 2018-04-13 |
| Last Update Date | 2024-03-04 |