| NPI | 1821532540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WM0705X Registered Nurse, Medical-Surgical (Licence: OH 349292) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 349292) |
| 373H00000X Day Training/Habilitation Specialist (Licence: OH 349292) | |
| Enumeration Date | 2016-12-14 |
| Last Update Date | 2016-12-14 |