| NPI | 1033355284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM CNP01098) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NM R45728) |
| Enumeration Date | 2008-12-17 |
| Last Update Date | 2024-04-30 |