| NPI | 1629785175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WV 112476) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0032446) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KY 3018483) | |
| Enumeration Date | 2022-11-03 |
| Last Update Date | 2025-05-08 |