| NPI | 1497105936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH RN.470395) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH PN.159381-M-IV) |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2024-02-16 |