| NPI | 1164191342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WM0705X Registered Nurse, Medical-Surgical (Licence: OH 473776) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: OH 473776) |
| Enumeration Date | 2021-09-10 |
| Last Update Date | 2021-09-10 |