| NPI | 1245529957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: OH APRN.CNP.025314) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN. 341675) |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2020-07-30 |