| NPI | 1518976711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: IA G116249) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 80427-030) |
| 363L00000X Nurse Practitioner (Licence: IA G116249) | |
| 163W00000X Registered Nurse (Licence: IA 116249) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2009-10-12 |