NPI | 1154761336 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704199433) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704199433) |
Enumeration Date | 2013-07-02 |
Last Update Date | 2023-03-07 |