| NPI | 1386745529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AL 1113909) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 186811) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 9365822) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 950018) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2019-12-04 |