| NPI | 1194164293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: HI APRN-2678) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: HI RN-75611) |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2025-01-10 |