| NPI | 1073906715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 231615) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 231615) |
| 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: NC 231615) | |
| Enumeration Date | 2015-03-05 |
| Last Update Date | 2015-03-05 |