NPI | 1982699476 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704194120) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4704194120) |
Enumeration Date | 2005-09-12 |
Last Update Date | 2021-02-15 |