| NPI | 1881301075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: ID 61604) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: ID 61604) |
| 363LF0000X Nurse Practitioner Family (Licence: ID 899421) | |
| Enumeration Date | 2022-10-28 |
| Last Update Date | 2022-12-22 |