| NPI | 1013798107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: OH APRN.CNP.0033645) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH APRN.CNP.0033645) |
| 364SP0809X Clinical Nurse Specialist Psychiatric/Mental Health, Adult (Licence: OH APRN.CNP.0033645) | |
| Enumeration Date | 2023-10-13 |
| Last Update Date | 2025-07-10 |