| NPI | 1275816902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ID NP-1114A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ID 23474-A) |
| Enumeration Date | 2011-09-20 |
| Last Update Date | 2025-06-07 |