| NPI | 1639425853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WH0200X Registered Nurse Home Health (Licence: OH 423804) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH PN.126891-M-IV) |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2021-04-20 |