| NPI | 1184054256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: SC 18579) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SC 18579) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IA 149956) | |
| Enumeration Date | 2013-11-26 |
| Last Update Date | 2022-03-16 |