NPI | 1487382008 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704291642) |
Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: MI 4704291642) |
Enumeration Date | 2022-08-11 |
Last Update Date | 2023-06-20 |