| NPI | 1578924130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NC 5008388) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NC 5008388) |
| Enumeration Date | 2016-03-10 |
| Last Update Date | 2022-07-25 |