| NPI | 1487280798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OH RN.530306) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2020-03-18 |
| Last Update Date | 2025-05-30 |