| NPI | 1700120946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0027653) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0027653) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: OH APRN.CNP.0027653) | |
| Enumeration Date | 2012-11-10 |
| Last Update Date | 2022-09-24 |