| NPI | 1669919452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NV 810059) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA SP017132) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV 810059) | |
| Enumeration Date | 2017-01-31 |
| Last Update Date | 2023-05-31 |