| NPI | 1306166194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OH pn129661) |
| Additional Taxonomies | 146M00000X Emergency Medical Technician, Intermediate (Licence: OH 0116973) |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2010-06-03 |