| NPI | 1699445544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0034859) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 417632) |
| Enumeration Date | 2021-09-14 |
| Last Update Date | 2025-01-06 |