| NPI | 1417519679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: MO 2023008359) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: MO 2019027482) |
| Enumeration Date | 2019-07-08 |
| Last Update Date | 2024-07-10 |