| NPI | 1699860809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH COA.15326.NP) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I10219) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2013-11-15 |