| NPI | 1497263834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.024744) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 417626) |
| Enumeration Date | 2018-01-19 |
| Last Update Date | 2020-12-09 |