| NPI | 1407398142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2350838) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA RN257139) |
| 363L00000X Nurse Practitioner (Licence: GA RN257139) | |
| Enumeration Date | 2016-11-11 |
| Last Update Date | 2021-04-26 |