| NPI | 1114313624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH RN.445324) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH PN.158433-M-IV) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OH RN.445324) | |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2017-11-14 |