| NPI | 1679853477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA RN115788-AP06562) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: LA AP06562) |
| Enumeration Date | 2011-08-24 |
| Last Update Date | 2024-04-05 |