| NPI | 1649588575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH RN.429968) |
| Additional Taxonomies | 405300000X Prevention Professional (Licence: OH 429968) |
| Enumeration Date | 2010-09-14 |
| Last Update Date | 2024-07-29 |