| NPI | 1972264422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0030079) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704384838) |
| Enumeration Date | 2022-01-06 |
| Last Update Date | 2023-11-03 |