| NPI | 1427348929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM 54434) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO 171197) |
| Enumeration Date | 2011-04-18 |
| Last Update Date | 2020-05-26 |