| NPI | 1558924647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OH LPN.171914.MEDS) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH LP410303) |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2021-10-11 |