| NPI | 1588950539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.12802) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MS R874300) |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2020-11-18 |