| NPI | 1780951996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 4697) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WI 4697) |
| Enumeration Date | 2011-11-17 |
| Last Update Date | 2021-04-20 |