| NPI | 1821663857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704302102) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704302102) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704302102) | |
| Enumeration Date | 2021-05-21 |
| Last Update Date | 2022-08-31 |