| NPI | 1427613983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH 338843) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1116930) |
| 163W00000X Registered Nurse (Licence: WV 85656) | |
| 163W00000X Registered Nurse (Licence: MN R199007-0) | |
| Enumeration Date | 2019-05-09 |
| Last Update Date | 2019-05-09 |