| NPI | 1134521081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KY 3008776) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: KY 3008776) |
| Enumeration Date | 2014-09-23 |
| Last Update Date | 2019-07-08 |