| NPI | 1942936752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: OH APRN.CNP.0032789) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704355591) |
| 363LA2100X Nurse Practitioner Acute Care (Licence: MI 4704355591) | |
| Enumeration Date | 2022-07-26 |
| Last Update Date | 2023-02-20 |