| NPI | 1023598414 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.023019) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH APRN.CNP.023019) |
| Enumeration Date | 2018-08-15 |
| Last Update Date | 2024-10-01 |