| NPI | 1104390350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.023196) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704308778) |
| Enumeration Date | 2019-01-21 |
| Last Update Date | 2024-06-17 |