| NPI | 1073218558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH RN.380915) |
| Additional Taxonomies | 163WA0400X Registered Nurse Addiction (Substance Use Disorder) (Licence: OH RN.380915) |
| Enumeration Date | 2023-04-03 |
| Last Update Date | 2023-04-04 |