| NPI | 1881051332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL arnp9271673) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL aprn9271673) |
| Enumeration Date | 2016-01-27 |
| Last Update Date | 2023-05-08 |