| NPI | 1265180640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: OH APRN.CNP.0032474) |
| Additional Taxonomies | 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: OH 344177) |
| Enumeration Date | 2022-03-14 |
| Last Update Date | 2023-10-23 |