| NPI | 1083188155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH RN.532981) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH LPN.168750.MEDS-IV) |
| Enumeration Date | 2019-01-11 |
| Last Update Date | 2024-03-06 |