| NPI | 1134196645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MI 4704171632) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704171632) |
| 363LF0000X Nurse Practitioner, Family (Licence: OH COA08670NP) | |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2022-10-03 |