| NPI | 1134685464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH 492799) |
| Additional Taxonomies | 163WR0400X Registered Nurse, Rehabilitation (Licence: OH 492799) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: OH 492799) | |
| Enumeration Date | 2019-02-12 |
| Last Update Date | 2022-01-07 |