| NPI | 1942550553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 938961) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH 144418) |
| Enumeration Date | 2012-09-12 |
| Last Update Date | 2018-12-03 |