| NPI | 1992180491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704283371) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704283371) |
| Enumeration Date | 2015-07-25 |
| Last Update Date | 2023-06-29 |