| NPI | 1508546375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704285727) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704285727) |
| 363L00000X Nurse Practitioner (Licence: MI 4704285727) | |
| Enumeration Date | 2023-07-18 |
| Last Update Date | 2023-09-20 |