| NPI | 1811620305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: OH PROCESSING) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: OH BEINGREVIEWED1) |
| Enumeration Date | 2022-07-02 |
| Last Update Date | 2022-07-06 |