| NPI | 1972001550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH CNP.0026902) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL APRN11019719) |
| 163W00000X Registered Nurse (Licence: OH RN435536) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11019719) | |
| Enumeration Date | 2018-01-29 |
| Last Update Date | 2022-12-01 |