| NPI | 1457857658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.023090) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.386802) |
| Enumeration Date | 2018-04-05 |
| Last Update Date | 2018-07-18 |