| NPI | 1942846365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH aprn.cnp.0032053) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.341572) |
| Enumeration Date | 2019-11-20 |
| Last Update Date | 2022-10-17 |