| NPI | 1245026939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CO RN.1684475) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.383220) |
| Enumeration Date | 2025-04-17 |
| Last Update Date | 2025-04-17 |