| NPI | 1255721734 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: OH 16979-np) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH 16979-NP) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: MI 4704372859) | |
| 363L00000X Nurse Practitioner (Licence: MI 4704372859) | |
| 363LF0000X Nurse Practitioner, Family (Licence: OH COA.16979-NP) | |
| Enumeration Date | 2015-02-04 |
| Last Update Date | 2021-04-29 |