| NPI | 1467890509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OH pn132933) |
| Additional Taxonomies | 251E00000X Home Health (Licence: OH pn132933) |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: OH pn132933) | |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2014-12-10 |