| NPI | 1518225341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0034954) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.419576) |
| Enumeration Date | 2012-04-30 |
| Last Update Date | 2024-09-03 |