| NPI | 1376814632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP012327) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN604622) |
| Enumeration Date | 2012-01-19 |
| Last Update Date | 2018-12-11 |