| NPI | 1518896224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0042365) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.466240) |
| Enumeration Date | 2026-05-18 |
| Last Update Date | 2026-06-09 |