| NPI | 1568085355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VT 101.0134751) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 706043) |
| 163W00000X Registered Nurse (Licence: VT 026.0142843) | |
| Enumeration Date | 2020-05-27 |
| Last Update Date | 2021-02-14 |