| NPI | 1639507551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ID NP 1389A) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MT NUR-RN-LIC-39018) |
| Enumeration Date | 2013-10-31 |
| Last Update Date | 2020-06-25 |