| NPI | 1316488810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OH LPN.136347.MEDS-IV) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 251E00000X Home Health | |
| Enumeration Date | 2017-03-16 |
| Last Update Date | 2025-01-16 |