| NPI | 1013294016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH 370014) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704286067) |
| Enumeration Date | 2011-11-04 |
| Last Update Date | 2011-11-04 |