NPI | 1003616327 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704371698) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704371698) |
Enumeration Date | 2025-03-17 |
Last Update Date | 2025-06-05 |