| NPI | 1982077749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0039922) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: OH LD7820) |
| 163W00000X Registered Nurse (Licence: OH RN.531219) | |
| Enumeration Date | 2015-11-02 |
| Last Update Date | 2025-08-20 |