| NPI | 1114177656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD 2019032907) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: MD 2019032907) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MD 07613) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 2019032907) | |
| Enumeration Date | 2008-09-20 |
| Last Update Date | 2020-10-05 |