| NPI | 1528481587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: LA AP07654) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: LA AP07654) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA AP07654) | |
| Enumeration Date | 2014-01-28 |
| Last Update Date | 2026-01-27 |