| NPI | 1033774955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OR 202105083NP-PP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704303766) |
| 163W00000X Registered Nurse (Licence: MI 4704303766) | |
| Enumeration Date | 2019-05-06 |
| Last Update Date | 2023-02-24 |