| NPI | 1154560092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX 835507) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH APRN.CNP.11769) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.11769) | |
| Enumeration Date | 2009-02-17 |
| Last Update Date | 2020-03-17 |