| NPI | 1699042002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP027820) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP011807) |
| Enumeration Date | 2011-11-30 |
| Last Update Date | 2024-08-19 |