| NPI | 1669212866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0039679) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.500720) |
| Enumeration Date | 2024-05-28 |
| Last Update Date | 2025-07-03 |