| NPI | 1376315861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OH LPN.195017) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.185558) |
| Enumeration Date | 2023-10-27 |
| Last Update Date | 2025-12-23 |