| NPI | 1306199856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OH PN. 130227-IV) |
| Additional Taxonomies | 374U00000X Home Health Aide |
| Enumeration Date | 2012-10-22 |
| Last Update Date | 2012-10-22 |