NPI | 1578997680 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MI 4704171488) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704171488) |
Enumeration Date | 2013-08-26 |
Last Update Date | 2025-06-11 |