| NPI | 1558816306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 8099) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ND R38492) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 295229) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ND R38492) | |
| Enumeration Date | 2016-08-22 |
| Last Update Date | 2023-07-18 |