| NPI | 1477068351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: MI PENDING) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: MI 4704287611) |
| Enumeration Date | 2017-12-13 |
| Last Update Date | 2017-12-13 |