| NPI | 1811475494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OH LPN.166363.MEDS-IV) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.499852) |
| Enumeration Date | 2018-08-05 |
| Last Update Date | 2021-12-30 |