| NPI | 1669628608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: SC 23553) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.0500406-CR) |
| 101YP2500X Counselor, Professional (Licence: OH C.0500406-CR) | |
| 363LF0000X Nurse Practitioner, Family (Licence: SC 23553) | |
| Enumeration Date | 2008-08-11 |
| Last Update Date | 2020-11-11 |