| NPI | 1952036923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0031870) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0031870) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024189902) | |
| Enumeration Date | 2022-07-22 |
| Last Update Date | 2024-05-16 |