| NPI | 1669862348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MO 2017002497) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: MO P-20168) |
| 146L00000X Emergency Medical Technician, Paramedic (Licence: MI 3201009993) | |
| 163W00000X Registered Nurse (Licence: MI 4704274228) | |
| 163WE0003X Registered Nurse, Emergency (Licence: MO 2016044503) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MO 2017002498) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MI 4704274228) | |
| Enumeration Date | 2015-02-02 |
| Last Update Date | 2018-02-13 |