| NPI | 1396111282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA RN261783) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD AC2002594) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024172863) | |
| Enumeration Date | 2015-08-14 |
| Last Update Date | 2019-02-13 |