| NPI | 1265624936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH COA.09532-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.324050-COA2) |
| 364SP0809X Clinical Nurse Specialist, Psych/Mental Health, Adult (Licence: OH COA.09583-NS) | |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2009-11-10 |