| NPI | 1811388093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OH PN075668IV) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: AZ LP041943) |
| Enumeration Date | 2015-02-10 |
| Last Update Date | 2016-05-17 |