| NPI | 1295041010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH 057528-23) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NH 057528-23) |
| Enumeration Date | 2010-08-31 |
| Last Update Date | 2017-01-04 |