NPI | 1003512856 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704371368) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704371368) |
Enumeration Date | 2023-02-03 |
Last Update Date | 2024-08-25 |