| NPI | 1497522817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH RN.543295) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH LPN.168157.MEDS-IV) |
| Enumeration Date | 2023-12-06 |
| Last Update Date | 2025-08-08 |