| NPI | 1386879948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WM0705X Registered Nurse, Medical-Surgical (Licence: OH 149863) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: IN 28168506A) |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2009-05-26 |