| NPI | 1164436119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704219053) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704219053) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2022-07-21 |