| NPI | 1740395466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 005002027) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC 005002027) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2024-01-17 |