| NPI | 1053078253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R215860) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: MD R215860) |
| Enumeration Date | 2021-11-22 |
| Last Update Date | 2024-10-24 |