| NPI | 1881858694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704351488) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: TX 683774) |
| 363L00000X Nurse Practitioner (Licence: TX AP116679) | |
| 363L00000X Nurse Practitioner (Licence: WI 9826) | |
| 363L00000X Nurse Practitioner (Licence: IA L154631) | |
| 363L00000X Nurse Practitioner (Licence: AZ AP11174) | |
| 363L00000X Nurse Practitioner (Licence: MI 4704351488) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 683774) | |
| Enumeration Date | 2008-07-11 |
| Last Update Date | 2023-01-16 |