| NPI | 1689878753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: MD R153729) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MD LPTA1998) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2023-07-11 |