| NPI | 1386341048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0035385) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.485265) |
| 163W00000X Registered Nurse (Licence: MI 4704379022) | |
| 363L00000X Nurse Practitioner (Licence: MI 4704379022) | |
| Enumeration Date | 2023-02-13 |
| Last Update Date | 2023-11-18 |