| NPI | 1639529951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH CNP.022256) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704299519) |
| Enumeration Date | 2016-06-17 |
| Last Update Date | 2021-05-04 |