| NPI | 1932610607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.021896) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MI APRN.CNP.021896) |
| Enumeration Date | 2017-10-20 |
| Last Update Date | 2025-10-02 |