| NPI | 1316491673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0029457) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.401849) |
| Enumeration Date | 2016-08-04 |
| Last Update Date | 2023-07-01 |