| NPI | 1780964932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH 025996) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.362463) |
| Enumeration Date | 2011-08-19 |
| Last Update Date | 2019-11-26 |