| 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 |