| NPI | 1588376115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OH 178995) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: KY 2053380) |
| Enumeration Date | 2022-12-14 |
| Last Update Date | 2022-12-14 |