| NPI | 1710743976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH RN.544818) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH lpn.182996.med-iv) |
| Enumeration Date | 2024-02-26 |
| Last Update Date | 2025-05-21 |