| NPI | 1982200515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0028421) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OH RN.456208) |
| Enumeration Date | 2020-12-09 |
| Last Update Date | 2021-02-19 |