| NPI | 1700915469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OH PN082169) |
| Additional Taxonomies | 374T00000X Religious Nonmedical Nursing Personnel (Licence: OH PN082169) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2016-03-09 |