| NPI | 1700494523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: KY 1129710) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.364060) |
| Enumeration Date | 2020-07-17 |
| Last Update Date | 2023-04-05 |