| NPI | 1770143430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP021192) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR19683600) |
| 163W00000X Registered Nurse (Licence: DE L1-0052335) | |
| 163W00000X Registered Nurse (Licence: PA RN694705) | |
| Enumeration Date | 2019-06-15 |
| Last Update Date | 2020-03-02 |