| NPI | 1538694617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.022430) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN 355455) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: OH 022430) | |
| Enumeration Date | 2017-04-26 |
| Last Update Date | 2020-12-31 |