| NPI | 1104307644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH LE-00028099) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: AZ RN196574) |
| 163W00000X Registered Nurse (Licence: AZ RN196574) | |
| 163W00000X Registered Nurse (Licence: OH RN.438160) | |
| Enumeration Date | 2018-08-23 |
| Last Update Date | 2019-08-13 |