| NPI | 1538358999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH CNP0027799) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH pn122155) |
| Enumeration Date | 2007-10-22 |
| Last Update Date | 2020-12-15 |