| NPI | 1225984479 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0042529) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.542797) |
| Enumeration Date | 2026-03-09 |
| Last Update Date | 2026-08-02 |