| NPI | 1467013433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 309175) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: HI APRN-3592) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 309175) | |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2023-11-27 |