| NPI | 1952347338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH COA.08571-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN245423) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2024-10-12 |