| NPI | 1215243654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704253925) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704253925) |
| Enumeration Date | 2010-08-23 |
| Last Update Date | 2011-06-21 |