| NPI | 1841503562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH RN357636) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 601155) |
| Enumeration Date | 2010-07-22 |
| Last Update Date | 2012-04-06 |