| NPI | 1427804228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KY 4044126) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.530441) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0039455) | |
| Enumeration Date | 2024-04-24 |
| Last Update Date | 2025-07-21 |