| NPI | 1487228144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH RN.454635) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2021-07-06 |