| NPI | 1760726608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 9520267-4405) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: AR R052805) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AR A003774) | |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2016-05-02 |