| NPI | 1356283212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.0041943) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.555666) |
| 163W00000X Registered Nurse (Licence: MI 4704406459) | |
| 363L00000X Nurse Practitioner (Licence: MI 4704406459) | |
| Enumeration Date | 2026-04-08 |
| Last Update Date | 2026-04-08 |