| NPI | 1780067363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH RN.441248) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH PN.153527-M-IV) |
| 164W00000X Licensed Practical Nurse (Licence: WV 33549) | |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2018-01-23 |