NPI | 1215414628 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH 0033633) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 24502) |
363LF0000X Nurse Practitioner, Family (Licence: FL APRN11014425) | |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 24502) | |
Enumeration Date | 2018-07-27 |
Last Update Date | 2023-10-11 |