| NPI | 1275893539 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OH 148938) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: OH 148938) |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2020-04-09 |