| NPI | 1558425868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704220074) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MI 4704220074) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2012-09-10 |