| NPI | 1295764892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV APRN002022) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP2829342) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2020-03-17 |