| NPI | 1417048968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.019734) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH E7706) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2021-01-06 |