| NPI | 1619252749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.12808-NP) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH aprn.cnp.12808) |
| Enumeration Date | 2011-10-20 |
| Last Update Date | 2020-12-01 |