| NPI | 1659857555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11010471) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: OH RN.414914) |
| 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.023064) | |
| Enumeration Date | 2018-07-13 |
| Last Update Date | 2022-06-29 |