| NPI | 1245801075 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT SEAN RAE CEO 330-536-3746 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2021-07-02 |
| Last Update Date | 2021-08-24 |