| NPI | 1740549799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: LA AP06883) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: LA AP06833) |
| Enumeration Date | 2012-05-11 |
| Last Update Date | 2018-10-12 |