| NPI | 1104558840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH RN.312167) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OH RN.312167) |
| Enumeration Date | 2022-06-30 |
| Last Update Date | 2025-01-05 |