| NPI | 1619635117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH 0030981) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 478286) |
| Enumeration Date | 2021-12-01 |
| Last Update Date | 2022-04-08 |