| NPI | 1740662394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IA G175305) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IA A126190) |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2023-09-28 |