| NPI | 1245753656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AK 132337) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV TAPRN701646) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV APRN002619) | |
| Enumeration Date | 2017-07-18 |
| Last Update Date | 2020-01-21 |