| NPI | 1295033835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH COA 12933-NP) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OH RN.347265) |
| Enumeration Date | 2011-03-07 |
| Last Update Date | 2025-07-31 |