| NPI | 1053437368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NY 099726-1) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH PN086707) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2007-07-09 |