| NPI | 1245756907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: DC 1024535) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MD AC002080) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD AC002080) | |
| Enumeration Date | 2017-08-15 |
| Last Update Date | 2025-04-18 |