| NPI | 1457894370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN9486534) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704325406) |
| 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.020112) | |
| Enumeration Date | 2016-11-25 |
| Last Update Date | 2020-11-17 |