| NPI | 1811230030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OH 150896) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: OH 150869) |
| Enumeration Date | 2013-04-05 |
| Last Update Date | 2013-04-05 |