| NPI | 1235482548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R222031) |
| Additional Taxonomies | 374U00000X Home Health Aide |
| Enumeration Date | 2012-10-24 |
| Last Update Date | 2021-12-01 |