| NPI | 1861918476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IN 71010058A) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.023281) |
| 163W00000X Registered Nurse (Licence: MA RN2318046) | |
| 163W00000X Registered Nurse (Licence: OH RN.450336) | |
| Enumeration Date | 2017-08-15 |
| Last Update Date | 2020-09-16 |