| NPI | 1023563996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WA0400X Registered Nurse Addiction (Substance Use Disorder) (Licence: OH #RN196007) |
| Additional Taxonomies | 261QM2800X Clinic/Center Methadone |
| Enumeration Date | 2016-08-22 |
| Last Update Date | 2016-08-22 |