| NPI | 1316312267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AR 226332) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR 226332) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MO 2023044102) | |
| Enumeration Date | 2015-12-03 |
| Last Update Date | 2024-09-17 |