| NPI | 1508232133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH RN.518625) |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician (Licence: OH PN128169MEDS) |
| Enumeration Date | 2015-08-18 |
| Last Update Date | 2023-07-12 |