| NPI | 1801592647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704321425) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704321425NSA2302O) |
| Enumeration Date | 2023-02-03 |
| Last Update Date | 2023-02-03 |