NPI | 1538674593 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OH 171929) |
Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: OH 164400) |
Enumeration Date | 2017-12-12 |
Last Update Date | 2019-07-29 |