| NPI | 1912695123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH 443765) |
| Additional Taxonomies | 163WN0300X Registered Nurse, Nephrology (Licence: OH 443765) |
| 163WH0500X Registered Nurse, Hemodialysis (Licence: OH 443765) | |
| Enumeration Date | 2023-04-26 |
| Last Update Date | 2023-04-26 |