| NPI | 1114955283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35067586B) |
| Additional Taxonomies | 163WW0000X Registered Nurse, Wound Care (Licence: OH 00000000000000000) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2021-09-15 |