| NPI | 1356658488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WV 102732) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.14610-NP) |
| Enumeration Date | 2010-09-10 |
| Last Update Date | 2026-02-24 |