| NPI | 1588094825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0027441) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0027441) |
| 164W00000X Licensed Practical Nurse (Licence: OH PN151753-M-IV) | |
| Enumeration Date | 2013-11-23 |
| Last Update Date | 2023-11-08 |