| NPI | 1598133571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WX0800X Registered Nurse Orthopedic (Licence: WV 60256) |
| Additional Taxonomies | 163WX0800X Registered Nurse Orthopedic (Licence: OH 398466) |
| Enumeration Date | 2015-09-09 |
| Last Update Date | 2015-09-09 |