| NPI | 1457930307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704302834) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: MI 4704302834) |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2022-11-04 |