| NPI | 1316938509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH RN 190418) |
| Additional Taxonomies | 364SP0809X Clinical Nurse Specialist, Psych/Mental Health, Adult (Licence: OH RN 190418) |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2007-07-08 |