| NPI | 1467906420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OH 152595) |
| Additional Taxonomies | 374U00000X Home Health Aide |
| 376K00000X Nurse's Aide | |
| Enumeration Date | 2016-08-08 |
| Last Update Date | 2024-03-19 |