| NPI | 1407203482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OH APRN.CNP.022658) |
| Additional Taxonomies | 163WA0400X Registered Nurse Addiction (Substance Use Disorder) (Licence: OH MA4767680) |
| 163WC1500X Registered Nurse Community Health (Licence: OH RN.397389-) | |
| 364SP0808X Clinical Nurse Specialist Psychiatric/Mental Health (Licence: OH APRN.CNP.022658) | |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2023-08-07 |