| NPI | 1013340744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: LA AP07380) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: LA AP07380) |
| 163W00000X Registered Nurse (Licence: LA RN124873) | |
| Enumeration Date | 2013-08-16 |
| Last Update Date | 2024-10-31 |