| NPI | 1699225680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OH LPN.124255.MEDS-IV) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH 124255) |
| Enumeration Date | 2016-10-13 |
| Last Update Date | 2020-10-16 |