| NPI | 1477169951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MI 4704338414) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.392567) |
| Enumeration Date | 2020-09-19 |
| Last Update Date | 2026-03-02 |