| NPI | 1538169792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH RN154376) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 154376) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2019-03-19 |