| NPI | 1407333164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DE L8-0000176) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD AC002383) |
| Enumeration Date | 2018-07-25 |
| Last Update Date | 2022-12-12 |