| NPI | 1396231338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OH LPN.166377.MEDIV) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH 166377) |
| Enumeration Date | 2018-07-02 |
| Last Update Date | 2018-07-02 |