NPI | 1306446547 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704336391) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704336391) |
Enumeration Date | 2020-10-27 |
Last Update Date | 2024-08-19 |