| NPI | 1437812161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: FL 11015406) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: FL 11015406) |
| Enumeration Date | 2021-10-19 |
| Last Update Date | 2024-02-07 |