| NPI | 1366941429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH RN.532735) |
| Additional Taxonomies | 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: OH 532735) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-02-05 |
| Last Update Date | 2025-03-07 |