| NPI | 1023593191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: PA SP019321) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NJ 26NJ01163300) |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: DE L8-0010596) | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: FL 11033113) | |
| Enumeration Date | 2018-09-25 |
| Last Update Date | 2024-08-06 |