| NPI | 1417578147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704306632) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704306632) |
| Enumeration Date | 2020-05-05 |
| Last Update Date | 2025-07-15 |