| NPI | 1194311902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH 290193) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1096155) |
| Enumeration Date | 2020-12-15 |
| Last Update Date | 2020-12-15 |