| NPI | 1689286726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0027191) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.424034) |
| 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0027191) | |
| Enumeration Date | 2020-08-19 |
| Last Update Date | 2020-09-03 |