| NPI | 1740537661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL RN9353169) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.375084) |
| Enumeration Date | 2012-08-09 |
| Last Update Date | 2013-03-01 |