| NPI | 1831928340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0041075) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: OH RN.343007) |
| Enumeration Date | 2024-08-01 |
| Last Update Date | 2026-03-27 |