| NPI | 1245435742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: AZ RN152227) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH PN105012) |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2008-07-24 |