| NPI | 1861729071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH COA15472NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.15472) |
| 163W00000X Registered Nurse (Licence: OH RN 350009) | |
| Enumeration Date | 2009-11-09 |
| Last Update Date | 2024-11-05 |