NPI | 1477923423 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH COA.18078.NP) |
Additional Taxonomies | 310500000X Intermediate Care Facility, Mental Illness (Licence: OH 31-1663568) |
Enumeration Date | 2015-10-03 |
Last Update Date | 2016-10-19 |