| NPI | 1588064208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DC RN1012522) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: DC RN1012522) |
| Enumeration Date | 2014-08-29 |
| Last Update Date | 2020-08-27 |