| NPI | 1598208050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5009240) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC 5009240) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5009240) | |
| Enumeration Date | 2016-11-30 |
| Last Update Date | 2024-08-07 |