| NPI | 1356622682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH 355927) |
| Additional Taxonomies | 163WI0500X Registered Nurse, Infusion Therapy (Licence: OH 355927) |
| 163WW0000X Registered Nurse, Wound Care (Licence: OH 355927) | |
| Enumeration Date | 2011-08-31 |
| Last Update Date | 2011-08-31 |