| NPI | 1851347215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: LA AP02734) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MS R603538) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2023-08-25 |