| NPI | 1578182184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704276691) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: MI 4704276691) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: MI 4704276691) | |
| Enumeration Date | 2020-04-14 |
| Last Update Date | 2021-03-30 |