| NPI | 1164427266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 364SP0808X Clinical Nurse Specialist Psychiatric/Mental Health (Licence: MD R113539) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: MD R113539) |
| 363L00000X Nurse Practitioner (Licence: MD R113539) | |
| 363LF0000X Nurse Practitioner Family (Licence: MD R1-3539) | |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2018-06-16 |