| NPI | 1811264963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DE L8-0010324) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP011120) |
| 363LF0000X Nurse Practitioner, Family (Licence: DE LG-0011641) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP025694) | |
| Enumeration Date | 2011-11-17 |
| Last Update Date | 2023-02-06 |