| NPI | 1861255812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MI 4704343820) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: HI APRN-4472-0) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 305584) | |
| Enumeration Date | 2024-02-02 |
| Last Update Date | 2024-10-24 |