| NPI | 1629200894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AK 117659) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AK 117659) |
| 363LF0000X Nurse Practitioner, Family (Licence: NM CNP-01518) | |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2025-02-01 |