| NPI | 1730603689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024179035) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024179035) |
| Enumeration Date | 2017-08-02 |
| Last Update Date | 2025-02-13 |