| NPI | 1407484181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0027902) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.312991) |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2021-04-26 |