| NPI | 1720743545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704300103) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704300103) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.0031011) | |
| Enumeration Date | 2021-11-05 |
| Last Update Date | 2023-03-17 |