| NPI | 1356082739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH RN.404365) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: KY 1157554) |
| 163WG0000X Registered Nurse, General Practice (Licence: OH RN.404365) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KY 1157554) | |
| Enumeration Date | 2022-04-07 |
| Last Update Date | 2022-11-08 |