| NPI | 1144841198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704306606) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: MI 4704306606) |
| Enumeration Date | 2020-04-30 |
| Last Update Date | 2020-09-28 |