| NPI | 1275854234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MS 905543) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MT 39936) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AL 1-070056) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MT 100781) | |
| Enumeration Date | 2010-06-14 |
| Last Update Date | 2022-09-14 |