| NPI | 1245047182 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0039029) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.478302) |
| Enumeration Date | 2024-12-13 |
| Last Update Date | 2026-01-26 |