| NPI | 1194178475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MS 901561) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MS 901561) |
| Enumeration Date | 2016-07-21 |
| Last Update Date | 2023-12-21 |