| NPI | 1104530914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0033170) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN472013) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024187175) | |
| Enumeration Date | 2023-01-06 |
| Last Update Date | 2024-02-21 |