| NPI | 1689235525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 403712) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 26141) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95012142) | |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2021-09-22 |