| NPI | 1942582846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH RN.380050) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH PN.130991IV) |
| Enumeration Date | 2011-09-15 |
| Last Update Date | 2012-06-15 |