| NPI | 1720818479 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704370092) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704370092) |
| Enumeration Date | 2024-08-07 |
| Last Update Date | 2025-02-12 |