| NPI | 1457739310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: OH 0029551) |
| Additional Taxonomies | 163WA0400X Registered Nurse Addiction (Substance Use Disorder) (Licence: OH 357112) |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2021-08-17 |