| NPI | 1932465457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 31706) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704254670) |
| 163W00000X Registered Nurse (Licence: MI 4704254670) | |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2022-07-13 |