| NPI | 1487319562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704322236) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 23427) |
| 363L00000X Nurse Practitioner (Licence: MN 9534) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MN 9534) | |
| Enumeration Date | 2021-11-03 |
| Last Update Date | 2024-01-16 |