| NPI | 1114175072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WM0705X Registered Nurse, Medical-Surgical (Licence: OH RN.281490) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: OH RN.281490) |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2008-09-04 |