| NPI | 1225039241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NE 111006) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ AP2504) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ RN046027) | |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2009-03-11 |