| NPI | 1629350863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH RN.424059) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH 145479) |
| Enumeration Date | 2011-09-14 |
| Last Update Date | 2016-03-15 |