| NPI | 1790294460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0037952) |
| Additional Taxonomies | 163WC0400X Registered Nurse, Case Management (Licence: OH RN.455453) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OH RN.455453) | |
| Enumeration Date | 2017-09-26 |
| Last Update Date | 2024-11-14 |