| NPI | 1134206873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IA G115825) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IA G-115825) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KS 75810) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MO 2013003487) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2020-09-16 |