NPI | 1750784484 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.16500) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.16500-NP) |
Enumeration Date | 2014-10-08 |
Last Update Date | 2021-12-15 |