| NPI | 1497520043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: OH PN.159260) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: WA LP61456239) |
| Enumeration Date | 2023-11-22 |
| Last Update Date | 2023-11-22 |