| NPI | 1144405580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: MD R119086) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: VA 0024168080) |
| Enumeration Date | 2008-01-03 |
| Last Update Date | 2016-03-14 |