| NPI | 1679114938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 251382) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 289041) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10006357) | |
| Enumeration Date | 2019-10-07 |
| Last Update Date | 2023-05-04 |