| NPI | 1609312420 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704261893) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704261893) |
| Enumeration Date | 2017-01-18 |
| Last Update Date | 2017-02-03 |