| NPI | 1215248893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH RN.379738) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2351185) |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2022-01-23 |