| NPI | 1396154050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP014037) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH COA.16943-NP) |
| Enumeration Date | 2014-08-07 |
| Last Update Date | 2022-09-09 |