| NPI | 1699909283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD AC001965) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 5004355) |
| Enumeration Date | 2009-05-11 |
| Last Update Date | 2017-03-09 |