| NPI | 1285040329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 18897) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: SC 18887) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: SC 18887) | |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2025-04-30 |