| NPI | 1215430764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704254251) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: MI 4704254251) |
| Enumeration Date | 2018-03-12 |
| Last Update Date | 2022-12-12 |