| NPI | 1083120687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R244372) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP018271) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP022041) | |
| Enumeration Date | 2017-12-18 |
| Last Update Date | 2024-09-06 |