| NPI | 1992067011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WH0200X Registered Nurse, Home Health (Licence: OH RN.482536) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH 159087) |
| 171W00000X Contractor | |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child | |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2020-10-04 |