| NPI | 1629239322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH COA14664NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN300112) |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2021-03-18 |