| NPI | 1588382410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NE 115140) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OH 352169) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IA G177174) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0034951) | |
| Enumeration Date | 2022-08-17 |
| Last Update Date | 2024-01-11 |