| NPI | 1467737056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OH PN107462) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: IN 27067019A) |
| Enumeration Date | 2011-10-14 |
| Last Update Date | 2012-02-16 |