| NPI | 1801432687 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704324289) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: MI 4704324289) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: MI 4704324289) | |
| Enumeration Date | 2019-11-27 |
| Last Update Date | 2024-06-04 |