| NPI | 1912324252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH 020963) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OH RN362272) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: OH APRNCNP020963) | |
| Enumeration Date | 2014-03-25 |
| Last Update Date | 2023-11-09 |