| NPI | 1831867555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: IN 71014328A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704351690) |
| Enumeration Date | 2021-08-30 |
| Last Update Date | 2024-09-25 |