| NPI | 1710210489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WG0000X Registered Nurse, General Practice (Licence: OH Rn521227) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OK 112658) |
| Enumeration Date | 2009-09-14 |
| Last Update Date | 2024-08-26 |