| NPI | 1396972253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OH PN- 131850 IV) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH PN-131850 IV) |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2009-06-18 |