| NPI | 1033667878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OH LPN.133610.MEDS-IV) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2016-09-21 |
| Last Update Date | 2016-09-21 |