| NPI | 1851440531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP009318) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R230746) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA RN502279L) | |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2018-06-29 |