| NPI | 1043769417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH 464243) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH 144432 IV-Med) |
| Enumeration Date | 2016-09-27 |
| Last Update Date | 2023-07-31 |