| NPI | 1184083032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0042354) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2016-02-21 |
| Last Update Date | 2026-06-11 |