| NPI | 1649763582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 813364) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH 023463) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV 813364) | |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2024-10-15 |