NPI | 1982150181 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MI 4704264505) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MI 4704264505) |
Enumeration Date | 2016-08-28 |
Last Update Date | 2022-12-01 |