| NPI | 1578014403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0034613) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN416819) |
| Enumeration Date | 2016-10-14 |
| Last Update Date | 2023-08-17 |