| NPI | 1437725058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WY 54163) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH 077749-23) |
| 363L00000X Nurse Practitioner (Licence: WY 54163) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AK 189420) | |
| Enumeration Date | 2021-06-03 |
| Last Update Date | 2024-11-08 |