| NPI | 1275873101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: HI APRN-3073) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DC RN1019762) |
| Enumeration Date | 2013-03-01 |
| Last Update Date | 2021-05-26 |