| NPI | 1407071087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 18989) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704203777) |
| 363L00000X Nurse Practitioner (Licence: CA 18989) | |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2017-05-10 |