| NPI | 1306417563 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704323389) |
| Additional Taxonomies | 163WL0100X Registered Nurse, Lactation Consultant (Licence: MI L-302211) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: MI 4704323389) | |
| Enumeration Date | 2021-07-08 |
| Last Update Date | 2021-08-25 |