NPI | 1336778562 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 163WA0400X Registered Nurse Addiction (Substance Use Disorder) (Licence: OH 474848) |
Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH 168215) |
Enumeration Date | 2020-04-08 |
Last Update Date | 2021-06-17 |