| NPI | 1629925151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0042290) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.542367) |
| Enumeration Date | 2026-03-13 |
| Last Update Date | 2026-06-04 |