| NPI | 1841830940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: SC 23603) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC MICH-JCGJ5) |
| Enumeration Date | 2020-01-07 |
| Last Update Date | 2020-05-20 |