| NPI | 1447639208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CT 5915) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CT 005915) |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2020-07-21 |