| NPI | 1497085963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MI 4704271364) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704271364) |
| 163WA0400X Registered Nurse Addiction (Substance Use Disorder) (Licence: MI 4704271364) | |
| 163WC3500X Registered Nurse Cardiac Rehabilitation (Licence: MI 4704271364) | |
| Enumeration Date | 2010-01-06 |
| Last Update Date | 2023-02-14 |