| NPI | 1407338031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WY 42009.1847) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KS 78352) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IA G155679) | |
| Enumeration Date | 2018-08-30 |
| Last Update Date | 2020-11-03 |