| NPI | 1497136394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: OH COA 115616-NP) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: OH RN 267061-1) |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: OH CTP 15616-EX1) | |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2015-08-20 |