| NPI | 1881045094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH 287083) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR16192000) |
| Enumeration Date | 2016-06-29 |
| Last Update Date | 2016-06-29 |