| NPI | 1467929927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704341344) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: OH RN.416348) |
| 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.023948) | |
| Enumeration Date | 2018-11-01 |
| Last Update Date | 2022-10-11 |