| NPI | 1518987718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 141268) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 141268) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2023-12-18 |