NPI | 1639560030 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MI 4704198315) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704198315) |
Enumeration Date | 2015-02-07 |
Last Update Date | 2023-12-12 |