NPI | 1992094403 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MI 4704259565) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704259565) |
Enumeration Date | 2011-04-05 |
Last Update Date | 2021-12-10 |