| NPI | 1376882191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA RN188113) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA 188113) |
| Enumeration Date | 2013-02-14 |
| Last Update Date | 2019-08-26 |