NPI | 1588150262 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MD AC002360) |
Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: MD R172482) |
Enumeration Date | 2018-07-06 |
Last Update Date | 2025-07-15 |