| NPI | 1740417088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0037627) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 346344) |
| Enumeration Date | 2009-06-13 |
| Last Update Date | 2024-10-15 |