| NPI | 1356897011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH 076534-23) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VT 101.0122906) |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2024-04-11 |