| NPI | 1922594746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH 023055) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH CNP023055) |
| Enumeration Date | 2018-07-04 |
| Last Update Date | 2023-08-21 |