NPI | 1740913201 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704341264) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704341264) |
Enumeration Date | 2022-07-02 |
Last Update Date | 2023-06-11 |