| NPI | 1730517608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.15007) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: OH APRN.CNP.15007) |
| Enumeration Date | 2013-10-31 |
| Last Update Date | 2022-09-22 |