NPI | 1356152383 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704388516) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704388516) |
Enumeration Date | 2025-01-17 |
Last Update Date | 2025-08-28 |