| NPI | 1033625637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH aprn.cnp.022886) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.391698) |
| Enumeration Date | 2017-12-18 |
| Last Update Date | 2018-06-18 |