| NPI | 1265774418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CT 7306) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 109834) |
| Enumeration Date | 2013-03-25 |
| Last Update Date | 2018-03-27 |