| NPI | 1205546348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OH PN.148572-M-IV) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.457637) |
| Enumeration Date | 2022-11-30 |
| Last Update Date | 2022-11-30 |