| NPI | 1376254243 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OH 173692) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 278898) |
| Enumeration Date | 2022-12-12 |
| Last Update Date | 2022-12-12 |