| NPI | 1235597048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.18740) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.18740-NP) |
| Enumeration Date | 2016-02-08 |
| Last Update Date | 2026-06-12 |