| NPI | 1063642510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 5938005-4408) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 5938005-3102) |
| Enumeration Date | 2009-07-17 |
| Last Update Date | 2014-05-27 |