| NPI | 1396340410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KY 3015957) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024187991) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IN 71010600A) | |
| Enumeration Date | 2020-12-04 |
| Last Update Date | 2024-03-18 |