| NPI | 1740803071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: OH RN336665) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.173724) |
| 163WC0400X Registered Nurse, Case Management (Licence: OH RN336665) | |
| 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: OH RN336665) | |
| Enumeration Date | 2020-05-21 |
| Last Update Date | 2025-12-18 |