NPI | 1881158749 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704306900) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI F11180493) |
Enumeration Date | 2019-01-24 |
Last Update Date | 2020-12-28 |