| NPI | 1417426495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: LA 229120) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: LA 129750) |
| Enumeration Date | 2018-11-19 |
| Last Update Date | 2023-02-15 |