| NPI | 1225587090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OH RN.245476) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH APRNCNP020902) |
| Enumeration Date | 2016-09-22 |
| Last Update Date | 2017-05-18 |