| NPI | 1306106240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024170083) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: SC 28300) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 25203) | |
| Enumeration Date | 2012-05-25 |
| Last Update Date | 2024-11-23 |