| NPI | 1477489557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0043315) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.561821) |
| 163W00000X Registered Nurse (Licence: MI 4704343819) | |
| Enumeration Date | 2026-06-18 |
| Last Update Date | 2026-09-09 |