| NPI | 1215251392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH COA.15191NP) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C0900108) |
| Enumeration Date | 2010-03-18 |
| Last Update Date | 2013-11-06 |