| NPI | 1750189320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0039461) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.531260) |
| Enumeration Date | 2025-03-07 |
| Last Update Date | 2025-06-11 |