| NPI | 1184991234 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704318832) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: MI 4704318832) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MI 2601000140) | |
| Enumeration Date | 2011-11-17 |
| Last Update Date | 2024-03-26 |