| NPI | 1205553252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NY F404552) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CO APN.0999111-NP) |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CT 12125) | |
| Enumeration Date | 2022-10-20 |
| Last Update Date | 2024-09-13 |