| NPI | 1528605912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD AC004082) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: DE LG-0001340) |
| 363LF0000X Nurse Practitioner, Family (Licence: MD AC004082) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: MD AC004082) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: DE LG-0001340) | |
| Enumeration Date | 2019-12-04 |
| Last Update Date | 2025-07-11 |