| NPI | 1447362736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TN 29396) |
| Additional Taxonomies | 2083A0300X Preventive Medicine Addiction Medicine (Licence: TN 29396) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2023-07-19 |