| NPI | 1427387935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM CNP-02670) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IN 71003143A) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: IN 28079761A) | |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NM RN-81594) | |
| Enumeration Date | 2009-12-11 |
| Last Update Date | 2015-06-25 |