NPI | 1902374267 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704289789) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704289789NSA180SS) |
Enumeration Date | 2018-11-05 |
Last Update Date | 2025-02-20 |