| NPI | 1609685056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WH0200X Registered Nurse, Home Health (Licence: OH 525946) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OH 525946) |
| 163W00000X Registered Nurse (Licence: MN 2485840) | |
| Enumeration Date | 2024-12-31 |
| Last Update Date | 2025-02-14 |