| NPI | 1023538022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0036546) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: OH RN350264) |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2024-08-15 |