| NPI | 1518272806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OH LPN.100044.MEDS) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: OH pn100044) |
| Enumeration Date | 2010-08-11 |
| Last Update Date | 2025-12-05 |