| NPI | 1558826214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NH 071987-23) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NH 071987-23) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH 071987-23) | |
| Enumeration Date | 2019-02-07 |
| Last Update Date | 2021-08-20 |