| NPI | 1881867182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: OH COA.17489-NP) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: OH I.0700380-SUPV) |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2015-07-27 |