| NPI | 1427107101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ AP3146) |
| Additional Taxonomies | 363LC1500X Nurse Practitioner, Community Health (Licence: MI 4704165653) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2021-08-03 |