| NPI | 1023181534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: RI 03339) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CT 2192) |
| 363LF0000X Nurse Practitioner, Family (Licence: CT 2192) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CT 2192) | |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2023-03-22 |