| NPI | 1578780946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AR A03250) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OK 0057700) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2023-09-07 |