| NPI | 1386637098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R180878) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN305565) |
| Enumeration Date | 2005-08-27 |
| Last Update Date | 2023-05-16 |