| NPI | 1487009957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: UT 8480668-4405) |
| Additional Taxonomies | 247200000X Technician, Other |
| Enumeration Date | 2016-05-03 |
| Last Update Date | 2022-10-01 |