| NPI | 1770245086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704386118) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 1057758) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1057758) | |
| Enumeration Date | 2021-10-13 |
| Last Update Date | 2023-04-03 |