NPI | 1649887662 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704311047) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704311047) |
Enumeration Date | 2020-09-24 |
Last Update Date | 2024-10-17 |