| NPI | 1609243609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WH0500X Registered Nurse, Hemodialysis (Licence: NE 78570) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NE 78570) |
| 163W00000X Registered Nurse (Licence: OH RN.360803) | |
| Enumeration Date | 2015-08-25 |
| Last Update Date | 2015-08-25 |