| NPI | 1205385432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CT 6732) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: CT 6732) |
| Enumeration Date | 2016-09-29 |
| Last Update Date | 2017-01-09 |