| NPI | 1134851751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0031656) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.406433) |
| Enumeration Date | 2022-06-30 |
| Last Update Date | 2024-01-14 |