| NPI | 1558515973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH RN339169) |
| Additional Taxonomies | 163WH0200X Registered Nurse Home Health (Licence: OH RN339169) |
| 163WM0705X Registered Nurse Medical-Surgical (Licence: OH RN339169) | |
| Enumeration Date | 2008-11-12 |
| Last Update Date | 2020-11-24 |