| NPI | 1902627730 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MI 4704369943) |
| Additional Taxonomies | 163WP2201X Registered Nurse, Ambulatory Care (Licence: MI 4704369943) |
| 207Q00000X Family Medicine (Licence: MI 4704369943) | |
| Enumeration Date | 2024-10-23 |
| Last Update Date | 2025-01-29 |