| NPI | 1629622584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH 025433) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 448833) |
| Enumeration Date | 2019-07-30 |
| Last Update Date | 2019-09-01 |