| NPI | 1811689144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704341949) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: WY 52167) |
| 163WF0300X Registered Nurse, Flight (Licence: HI 90980) | |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: WY 52167) | |
| 363LF0000X Nurse Practitioner, Family (Licence: WY 52167) | |
| Enumeration Date | 2023-05-24 |
| Last Update Date | 2024-08-11 |