| NPI | 1740773290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.022675) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704241472NSA18486) |
| Enumeration Date | 2018-06-10 |
| Last Update Date | 2018-06-10 |