| 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 |