| NPI | 1144576190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: FL ARNP9336620) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: FL ARNP9336620) |
| 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: FL RN9336620) | |
| Enumeration Date | 2012-07-27 |
| Last Update Date | 2023-08-16 |