| NPI | 1740410810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: MN CNP 4692) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: WY 18740.1004) |
| Enumeration Date | 2009-07-22 |
| Last Update Date | 2016-10-06 |