| NPI | 1639436975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704175219) |
| Additional Taxonomies | 163WP2201X Registered Nurse, Ambulatory Care (Licence: MI 4704175219) |
| Enumeration Date | 2012-04-11 |
| Last Update Date | 2020-10-23 |