| NPI | 1043542962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH RN.350309-) |
| Additional Taxonomies | 163WW0000X Registered Nurse Wound Care (Licence: OH RN.350309) |
| 164W00000X Licensed Practical Nurse (Licence: OH PN.128876-M-IV) | |
| Enumeration Date | 2010-02-03 |
| Last Update Date | 2025-01-22 |