| NPI | 1003285859 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MI 4704278975) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704278975) |
| 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: MI 4704278975) | |
| 364SG0600X Clinical Nurse Specialist, Gerontology (Licence: MI 4704278975) | |
| 364SP2800X Clinical Nurse Specialist, Perioperative (Licence: MI 4704278975) | |
| Enumeration Date | 2015-09-23 |
| Last Update Date | 2018-03-17 |