| NPI | 1487062543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5010687) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 307000) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5010687) | |
| Enumeration Date | 2014-07-31 |
| Last Update Date | 2023-04-27 |