| NPI | 1316457534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: MD R205253) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: MD R205253) |
| Enumeration Date | 2017-10-02 |
| Last Update Date | 2025-09-06 |