| NPI | 1235548314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R216155) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MD R216155) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: MD R216155) | |
| Enumeration Date | 2014-08-04 |
| Last Update Date | 2023-05-19 |