| NPI | 1225521511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI APRN.CNP.022867) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH 022867) |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2024-10-12 |