| NPI | 1861849457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024189953) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: NY 674198-1) |
| 363LF0000X Nurse Practitioner, Family (Licence: NY F339851-1) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD AC007554) | |
| Enumeration Date | 2016-05-24 |
| Last Update Date | 2025-05-08 |