NPI | 1174357370 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MI 4704360900) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704360900) |
Enumeration Date | 2024-08-29 |
Last Update Date | 2024-11-04 |