| NPI | 1164854295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH COA.14891-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.14891-NP) |
| Enumeration Date | 2013-07-31 |
| Last Update Date | 2019-08-20 |