| NPI | 1508365016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704373408) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1132736) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.022342) | |
| 163W00000X Registered Nurse (Licence: OH RN.419535) | |
| Enumeration Date | 2018-02-09 |
| Last Update Date | 2024-01-31 |