| NPI | 1942702014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 202007113NP-PP) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.160241) |
| 163W00000X Registered Nurse (Licence: OH RN.458469) | |
| Enumeration Date | 2018-03-06 |
| Last Update Date | 2020-08-07 |