| NPI | 1780225458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5012442) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5012442) |
| 363L00000X Nurse Practitioner (Licence: NC 5012442) | |
| Enumeration Date | 2019-10-03 |
| Last Update Date | 2026-02-03 |