| NPI | 1487185666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD AC002070) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001232368) |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2017-07-24 |