| NPI | 1326229386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH RN.419504) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH PN120639) |
| Enumeration Date | 2007-11-19 |
| Last Update Date | 2018-03-17 |