NPI | 1629757307 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704324445) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704324445NSA230IK) |
Enumeration Date | 2023-07-12 |
Last Update Date | 2023-07-12 |