| NPI | 1225419625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5007671) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 5007671) |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 5007671) | |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2021-08-13 |