| NPI | 1720171333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NM 76791) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: OH pn111281) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2022-07-21 |