| NPI | 1831641679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.019998) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704286708) |
| Enumeration Date | 2016-10-27 |
| Last Update Date | 2025-05-20 |