| NPI | 1518542844 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704306266) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704306266) |
| Enumeration Date | 2021-03-17 |
| Last Update Date | 2021-04-24 |