| NPI | 1578533956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 201940) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: RI APRN04172) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209029992) | |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2024-08-27 |