| NPI | 1558767392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME133899) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9327250) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN21096) | |
| Enumeration Date | 2014-11-05 |
| Last Update Date | 2019-12-21 |