| NPI | 1740669332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11001406) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704341774) |
| 363L00000X Nurse Practitioner (Licence: NY 343842) | |
| 363LF0000X Nurse Practitioner, Family (Licence: OH COA.17371-NP) | |
| 363L00000X Nurse Practitioner (Licence: OH 17371-NP) | |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2025-07-03 |