| NPI | 1235742024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0037315) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704316654) |
| Enumeration Date | 2020-08-31 |
| Last Update Date | 2024-08-15 |