| NPI | 1427724848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704273382) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 20134120526) |
| 363L00000X Nurse Practitioner (Licence: MI 20134120526) | |
| Enumeration Date | 2021-08-17 |
| Last Update Date | 2021-09-07 |