| NPI | 1093999732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH RN352591) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH PN-112704) |
| Enumeration Date | 2007-12-17 |
| Last Update Date | 2012-02-02 |