| NPI | 1154102291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH RN.505711) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN656800) |
| Enumeration Date | 2023-10-12 |
| Last Update Date | 2023-10-12 |