| NPI | 1669926812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704255895) |
| Additional Taxonomies | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: MI 4704255895) |
| Enumeration Date | 2016-08-04 |
| Last Update Date | 2020-04-01 |