| NPI | 1023367638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OH PN.140647-MEDS) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: OH 158474) |
| 164X00000X Licensed Vocational Nurse (Licence: TX 227553) | |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2012-08-29 |