| NPI | 1659625770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704267522) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.0030116) |
| 364SA2100X Clinical Nurse Specialist, Acute Care (Licence: UT 8880071-4405) | |
| Enumeration Date | 2012-10-29 |
| Last Update Date | 2022-11-29 |