| NPI | 1487971412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5017230) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC C007267) |
| Enumeration Date | 2010-04-30 |
| Last Update Date | 2023-03-01 |