| NPI | 1437748936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0028301) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH IR.967585) |
| 163W00000X Registered Nurse (Licence: TN 240742) | |
| Enumeration Date | 2021-01-11 |
| Last Update Date | 2021-02-09 |