| NPI | 1699746099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024193670) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 3122672) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL ARNP3122672) | |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2026-02-19 |