| NPI | 1760656144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OH PN 128629) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH 128629) |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2008-04-17 |