| NPI | 1023099637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WY 19109.0857) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WY 19109.0857) |
| 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: WY 19109.0857) | |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2016-11-09 |