| NPI | 1225587926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OH 157768) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH LPN157768) |
| Enumeration Date | 2016-09-23 |
| Last Update Date | 2025-06-04 |