| NPI | 1407507908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WC1500X Registered Nurse, Community Health (Licence: OH RN.533016) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH LPN.171613.MED-IV) |
| Enumeration Date | 2022-01-16 |
| Last Update Date | 2025-10-01 |