| NPI | 1275301541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: PA PN312225) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH LPN.181215.MEDS) |
| Enumeration Date | 2023-12-18 |
| Last Update Date | 2023-12-18 |