| NPI | 1518493634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH 067829-23) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH 067829-21) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CT 8841) | |
| Enumeration Date | 2017-05-10 |
| Last Update Date | 2021-05-13 |