| NPI | 1891340808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH 026281) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH 026281) |
| Enumeration Date | 2019-08-06 |
| Last Update Date | 2023-04-29 |