| NPI | 1730756461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MI 4704290761) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: MI 10760992) |
| 163W00000X Registered Nurse (Licence: MI 4704290761) | |
| Enumeration Date | 2021-06-10 |
| Last Update Date | 2021-08-11 |