| NPI | 1760846612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OH LPN.094129.MEDS) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH PN094129-Meds) |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2023-02-06 |