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 |