| NPI | 1538565692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH RN440864) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: OH 401693781014) |
| Enumeration Date | 2014-11-17 |
| Last Update Date | 2025-09-20 |