| NPI | 1285164236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 317986-4405) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: UT 317986-3102) |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2019-07-22 |