| NPI | 1437740180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AR 217583) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MO 2023010164) |
| Enumeration Date | 2021-01-26 |
| Last Update Date | 2023-05-22 |