| NPI | 1134487796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: MI 4704228655) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 20973) |
| Enumeration Date | 2012-05-01 |
| Last Update Date | 2019-03-17 |