| NPI | 1659808103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DC NP500006915) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ AP10076) |
| Enumeration Date | 2017-05-15 |
| Last Update Date | 2023-02-11 |