| NPI | 1346530557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ID NP-1399A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ID NP-1399A) |
| Enumeration Date | 2011-04-10 |
| Last Update Date | 2019-04-07 |