| NPI | 1285453589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0037778) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.434911) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH APRN.CNP.0037778) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH LE-00054070) | |
| Enumeration Date | 2024-10-04 |
| Last Update Date | 2024-12-24 |