| NPI | 1457610263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R227138) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH 135231) |
| Enumeration Date | 2012-05-14 |
| Last Update Date | 2024-02-08 |