| NPI | 1508255068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP029603) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95001897) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV APRN002549) | |
| Enumeration Date | 2015-01-21 |
| Last Update Date | 2026-06-29 |