| NPI | 1548698434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5006566) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC 5006566) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024186979) | |
| Enumeration Date | 2013-10-31 |
| Last Update Date | 2023-12-05 |