| NPI | 1154761336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704199433) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704199433) |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2023-03-07 |