| NPI | 1568948313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO 0993983) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IN 71014881A) |
| Enumeration Date | 2018-07-16 |
| Last Update Date | 2024-02-12 |