| NPI | 1558655571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH RN.437541) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH PN-144208-M-IV) |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2017-08-14 |