| NPI | 1548329931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NH 047435-23-03) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH 047435-23-08) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2007-07-08 |