| NPI | 1124459151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WA0400X Registered Nurse Addiction (Substance Use Disorder) (Licence: OH RN.378059) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 378059) |
| 163WH0200X Registered Nurse Home Health (Licence: OH 378059) | |
| 163WP0809X Registered Nurse Psychiatric/Mental Health, Adult (Licence: OH 378059) | |
| Enumeration Date | 2013-12-02 |
| Last Update Date | 2019-10-02 |