NPI | 1689121394 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0033216) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.421081) |
Enumeration Date | 2016-09-10 |
Last Update Date | 2023-02-21 |