| NPI | 1780205179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704271224) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: MI 4704271224) |
| Enumeration Date | 2020-04-27 |
| Last Update Date | 2024-03-28 |