| NPI | 1750784484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/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 |