| NPI | 1396171385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R229551) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: SC 18462) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD AC001257) | |
| Enumeration Date | 2013-09-23 |
| Last Update Date | 2017-12-05 |