| NPI | 1164980934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0030192) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.408190) |
| Enumeration Date | 2019-03-11 |
| Last Update Date | 2021-11-10 |