| NPI | 1528330685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OH PN 145043) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: MI 4703108361) |
| Enumeration Date | 2012-02-06 |
| Last Update Date | 2012-02-06 |