NPI | 1841649415 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: OH RN222372) |
Additional Taxonomies | 101Y00000X Counselor (Licence: OH LICDCII.161554) |
163WA2000X Registered Nurse, Administrator (Licence: OH RN222372) | |
Enumeration Date | 2016-06-06 |
Last Update Date | 2019-05-21 |