| NPI | 1093239717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.021111) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH CNP.021111) |
| Enumeration Date | 2017-08-03 |
| Last Update Date | 2024-09-28 |