| NPI | 1477250363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH 0033872) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704394426) |
| 163W00000X Registered Nurse (Licence: MI 4704394426) | |
| 163W00000X Registered Nurse (Licence: OH 401688) | |
| Enumeration Date | 2023-02-10 |
| Last Update Date | 2024-10-16 |