| NPI | 1073953261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN 4553) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 201608563NP-PP) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WV APRN91284NP) | |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2018-05-02 |