| NPI | 1396045274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH 370338) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH E. 0003530) |
| Enumeration Date | 2010-10-26 |
| Last Update Date | 2016-07-19 |