| NPI | 1215460357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: OH 491728) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: OH 491728) |
| 164W00000X Licensed Practical Nurse (Licence: OH LPN.146338.MED S-IV) | |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2023-01-31 |