| NPI | 1992207641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: OH APRN.CNP.023345) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 434715) |
| Enumeration Date | 2018-03-07 |
| Last Update Date | 2019-03-21 |