| NPI | 1659085496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0036290) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.503889) |
| 163W00000X Registered Nurse (Licence: MI 4704315412) | |
| Enumeration Date | 2023-01-06 |
| Last Update Date | 2024-07-12 |