| NPI | 1063506608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OH PN100815) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: FL PN5148848) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2007-07-08 |