| NPI | 1750693768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH RN.379594) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OH 0441) |
| Enumeration Date | 2010-07-07 |
| Last Update Date | 2017-08-24 |