| NPI | 1700336781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9488436) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.020108) |
| 363LF0000X Nurse Practitioner, Family (Licence: MI 4704325400) | |
| Enumeration Date | 2016-10-13 |
| Last Update Date | 2019-03-17 |