| NPI | 1831531292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH RN.456374) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH PN153016MIV) |
| Enumeration Date | 2013-07-25 |
| Last Update Date | 2019-04-30 |