| NPI | 1376963975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD AC001189) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: DE LG-0000724) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD AC002929) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DE L8-0000215) | |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2023-10-15 |