| NPI | 1881657237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH 19136) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH 19136) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 23345) | |
| 363LF0000X Nurse Practitioner, Family (Licence: AK 897) | |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2024-04-02 |