| NPI | 1457681850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: LA AP05951) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: LA RN110727 AP05951) |
| Enumeration Date | 2010-01-06 |
| Last Update Date | 2019-07-18 |