| NPI | 1144747312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD AC003349) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DC RN1058910) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 24183650) | |
| Enumeration Date | 2017-08-28 |
| Last Update Date | 2024-06-27 |