| NPI | 1760226583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0038409) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704307755) |
| 163W00000X Registered Nurse (Licence: OH 360748) | |
| Enumeration Date | 2024-06-25 |
| Last Update Date | 2025-05-12 |