| NPI | 1144091703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0036679) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.1451278) |
| 163W00000X Registered Nurse (Licence: OH RN.519895) | |
| 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0036679) | |
| Enumeration Date | 2024-01-12 |
| Last Update Date | 2024-07-22 |