| NPI | 1962740811 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MI 4704287327) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704287327) |
| Enumeration Date | 2013-01-28 |
| Last Update Date | 2021-03-11 |