| NPI | 1295992097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 6685217-4405) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 6685217-3102) |
| 164W00000X Licensed Practical Nurse (Licence: UT 6685217-3101) | |
| 247200000X Technician, Other | |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2020-07-01 |