| NPI | 1407848864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 201451) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 201451) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: NC 201451) | |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2009-06-26 |