| NPI | 1053761890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.025844) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC 5008610) |
| 363LF0000X Nurse Practitioner, Family (Licence: OR 10019107) | |
| 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.025844) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10019107) | |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2024-07-03 |