| NPI | 1154893501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH 374200) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 363LP0808X) |
| Enumeration Date | 2018-12-26 |
| Last Update Date | 2020-03-12 |