| NPI | 1184040487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP016803) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN653205) |
| Enumeration Date | 2014-03-11 |
| Last Update Date | 2018-12-27 |