| NPI | 1811237514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: UT 12052515-4405) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NV APRN001847) |
| Enumeration Date | 2013-02-18 |
| Last Update Date | 2021-03-11 |