| NPI | 1225496391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 6597871-4405) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: UT 65978714405) |
| Enumeration Date | 2016-02-04 |
| Last Update Date | 2022-11-04 |