| NPI | 1578002440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AL 2018008534) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AL F1216314) |
| Enumeration Date | 2017-02-13 |
| Last Update Date | 2021-07-22 |