| NPI | 1538815774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704327082) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704327082NSA2205T) |
| Enumeration Date | 2022-02-25 |
| Last Update Date | 2022-11-29 |