| NPI | 1396252946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.022047) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704339712) |
| Enumeration Date | 2018-01-04 |
| Last Update Date | 2023-11-03 |