| NPI | 1598880536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DC 1043976) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 111458) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: DC 1043976) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2022-07-21 |