| NPI | 1194240937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.024473) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.024473) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WV 94378) | |
| Enumeration Date | 2017-08-12 |
| Last Update Date | 2021-11-26 |