| NPI | 1356670020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OH 118682) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: DC LPN1008767) |
| Enumeration Date | 2009-12-09 |
| Last Update Date | 2023-04-13 |