| NPI | 1750386900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH 074751-23) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9218687) |
| 363LF0000X Nurse Practitioner, Family (Licence: NH 07475123) | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: FL ARNP9218687) | |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2020-10-29 |