| NPI | 1760757413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.021132) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.1100541) |
| 163W00000X Registered Nurse (Licence: OH RN.416107) | |
| Enumeration Date | 2012-03-14 |
| Last Update Date | 2022-07-21 |