| NPI | 1003107574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WM0705X Registered Nurse, Medical-Surgical (Licence: OH 354186) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: TX 208988) |
| Enumeration Date | 2011-05-02 |
| Last Update Date | 2011-05-02 |