| NPI | 1871915710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IA A124715) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IA A124715) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: IA A124715) | |
| Enumeration Date | 2014-01-13 |
| Last Update Date | 2022-12-15 |