| NPI | 1053661074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IA G136472) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ AP4663) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA RN176776) | |
| Enumeration Date | 2012-09-17 |
| Last Update Date | 2020-05-03 |