| NPI | 1982539847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH RN.505085) |
| Additional Taxonomies | 247200000X Technician, Other (Licence: OH 158799) |
| Enumeration Date | 2026-06-15 |
| Last Update Date | 2026-06-15 |