| NPI | 1821569757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH 533441) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH 169977) |
| Enumeration Date | 2018-12-17 |
| Last Update Date | 2025-09-12 |