| NPI | 1174970883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV 832251) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.19140-NP) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN9485699) | |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2024-11-04 |