| NPI | 1316312267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: AR 226332) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CO APN.0995642-NP) |
| Enumeration Date | 2015-12-03 |
| Last Update Date | 2024-03-21 |