| NPI | 1588904858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 337449) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101284383) |
| 207Q00000X Family Medicine (Licence: CO DR.0074745) | |
| 207Q00000X Family Medicine (Licence: MN 78700) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CT 005699) | |
| Enumeration Date | 2013-02-25 |
| Last Update Date | 2025-04-01 |