| NPI | 1679964688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MD AC001477) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: DE LG-0000826) |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: MD AC003915) | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: DE L8-0010264) | |
| Enumeration Date | 2015-02-12 |
| Last Update Date | 2021-11-09 |