| NPI | 1831705060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704299720) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: MI 3201011490) |
| 163W00000X Registered Nurse (Licence: MI 4704299720) | |
| Enumeration Date | 2020-09-22 |
| Last Update Date | 2020-09-22 |