| NPI | 1003265679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 9430045) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: VA 0001242740) |
| 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: WV 93000) | |
| 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: FL 9430045) | |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2016-09-16 |