| NPI | 1750732459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IA G164907) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IA A146166) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KS 77289) | |
| Enumeration Date | 2016-06-24 |
| Last Update Date | 2023-05-12 |