| NPI | 1386361368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH 0032111) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KY 3019060) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: SC 26716) | |
| Enumeration Date | 2022-10-20 |
| Last Update Date | 2023-02-23 |