| NPI | 1649921289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH 2022041853) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.426697) |
| Enumeration Date | 2022-01-14 |
| Last Update Date | 2022-10-19 |