| NPI | 1356375786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704127778) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: MI 4704127778) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2020-12-15 |