| NPI | 1013798107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OH APRN.CNP.0033645) |
| Additional Taxonomies | 364SP0809X Clinical Nurse Specialist, Psych/Mental Health, Adult (Licence: OH APRN.CNP.0033645) |
| Enumeration Date | 2023-10-13 |
| Last Update Date | 2023-11-09 |