NPI | 1194590810 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704258725) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 35557) |
Enumeration Date | 2023-11-22 |
Last Update Date | 2024-10-16 |