| NPI | 1033980511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61611190) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0036839) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ID 9071647) | |
| 163W00000X Registered Nurse (Licence: OH RN.518828) | |
| Enumeration Date | 2024-01-12 |
| Last Update Date | 2025-09-29 |