| NPI | 1710334198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.19011-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704278057) |
| Enumeration Date | 2016-05-16 |
| Last Update Date | 2016-05-16 |